Appendix E
Boating Accident Report
E-4
For each question below, please provide answers IF APPLICABLE AND IF KNOWN, otherwise leave blank.
ACCIDENT DETAILS
–
YOUR
BOAT-
INJURED PEOPLE RECEIVING
OR IN NEED OF
TREATMENT BEYOND FIRST AID
5HSRUWRQO\
injured people on, struck by, or being towed by
\RXUERDW
, receiving
RULQQHHGRI
treatment beyond first aid.
'RQRWUHSRUW
injured people on, struck by, or being towed by
DQRWKHUERDWRUQRERDW
(e.g., swimmers, people on a dock).
,IPRUHWKDQRQH
injured person
to report, attach additional copies of this page.
,IQRQH
, SKIP INJURED PEOPLE section.
INJURED PERSON
First Name
MI
Last Name
Street
City
State
Zip
Phone
Date of Birth
PPGG\\\\
Age
INJURY DETAILS
Injury caused when person
VHOHFWDOOWKDWDSSO\
Nature of most serious injury
VHOHFWRQH
Struck the
HJERDWZDWHU
Scrape/bruise
Dislocation
Was struck by a
HJERDWSURSHOOHU
Cut
Internal organ injury
Was exposed to carbon monoxide poisoning
Sprain/strain
Amputation
Received an electric shock
Concussion/brain injury
Burn
Other
GHVFULEH
Spinal cord injury
Other
GHVFULEH
Person was wearing lifejacket?
Yes
No
Broken/fractured bone
Person received treatment beyond first aid?
Yes
No
Body part of
PRVWVHULRXV
injury
HJKHDGWUXQNOHJ
Person was admitted to a hospital?
Yes
No
ACCIDENT DETAILS
–
YOUR
BOAT
–
DEATHS/DISAPPEARANCES
2QO\
report deaths/disappearances of people on, struck by, or being towed by
\RXUERDW
.
If more than one death/disappearance to report, attach additional copies of this page.
,IQRQH
, SKIP DEATHS/DISAPPEARANCES section.
PERSON WHO DIED/DISAPPEARED
First Name
MI
Last Name
Street
City
State
Zip
Phone
Date of Birth
PPGG\\\\
Age
DETAILS OF DEATH/DISAPPEARANCE
Injury caused when person
VHOHFWDOOWKDWDSSO\
Nature of death/disappearance
VHOHFWRQH
Struck the
HJERDWZDWHU
Death
±
by drowning
Was struck by a
HJERDW
SURSHOOHU
Death
±
other likely cause
GHVFULEH
Was exposed to carbon monoxide poisoning
Received an electric shock
Disappeared and not yet recovered
Other
GHVFULEH
Person was wearing lifejacket?
Yes
No
CG-3865 ( /1 ) Page 4 of 6
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Страница 1: ...2022 STANDARDS OPTIONS 2022 OWNERS MANUAL ...
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Страница 16: ...A 2 This page intentionally left blank ...
Страница 34: ...EXTERIOR EQUIPMENT FEATURES 1 18 43 OPEN This page intentionally left blank ...
Страница 62: ...ELECTRICAL SYSTEMS 4 10 43 OPEN Operator Notes ...
Страница 105: ...ROUTINE MAINTENANCE 7 19 43 OPEN Figure 7 10 The A C unit The arrow points to the mesh filter ...
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Страница 126: ...Appendix C Maintenance Guides C 2 Operator Notes ...
Страница 128: ...Appendix D Maintenance Schedule D 2 Date Hours Dealer Service Repairs ...
Страница 129: ...Maintenance Schedule Appendix D D 3 Date Hours Dealer Service Repairs ...
Страница 130: ...Appendix D Maintenance Schedule D 4 Date Hours Dealer Service Repairs ...
Страница 137: ...Float Plan Appendix F F 1 Float Plan ...
Страница 138: ...Appendix F Float Plan F 2 ...
Страница 140: ...Appendix F Float Plan F 4 Operator Notes ...
Страница 144: ...Appendix G Troubleshooting Guide G 4 Operator Notes ...
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Страница 159: ...Operator Notes ...
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